J Korean Foot Ankle Soc.  2023 Jun;27(2):49-54. 10.14193/jkfas.2023.27.2.49.

Relationship between Ischemia–Modified Albumin and the Healing Period of Amputation Wounds in Patients with Diabetes Mellitus Following Non-traumatic Below-Knee Amputation

• Heo SY
• Lee MJ
• Kim Hj
• Byun SB

• KMID: 2543000
• DOI: http://doi.org/10.14193/jkfas.2023.27.2.49

Abstract

Purpose
The present study examined the effectiveness of the preoperative ischemia-modified albumin (IMA) levels in predicting the healing period of amputation wounds in patients with diabetes mellitus following a non-traumatic below-knee amputation (BKA).
Materials and Methods
This study enrolled 41 diabetic foot ulcer patients who underwent BKA at the authors’ hospital diabetic foot center from April 2016 to April 2022. Among the 41 patients, 29 (70.7%) were male and 12 (29.3%) were female. Their mean age was 64.54±11.38 years (41~81 years). The mean follow-up period was 19.48±5.56 weeks (14~48 weeks) after BKA. The patients were divided into two groups (high IMA group and normal IMA group), which evaluated the healing period, wound dehiscence, and revision operation rate using a Fisher's exact test and Mann–Whitney U test. Three orthopedic surgeons performed stump wound evaluation, and they were evaluated as healing when all sutures were fused without oozing.
Results
Thirty patients (73.2%) (group A) showed a high level of IMA (median: 91.2 U/mL), and 11 (26.8%) patients (group B) showed a normal range of IMA (median: 82.7 U/mL). In group A, the median period for wound healing took 1.4 weeks longer, which was significant (p=0.001). No statistical relationship was observed between wound dehiscence, revision operation rate, and IMA value. There was no correlation between the other risk factors (estimated glomerular filtration rate, HbA1c) and the wound healing period.
Conclusion
Although there was a limitation in using IMA as the sole factor to predict the healing period of amputation wounds in patients after BKA, this study revealed a significant positive correlation between IMA and the period of stump healing after BKA. Therefore, the preoperative IMA levels may help predict the period of stump healing after BKA.

Keyword

Diabetic foot; Foot ulcer; Ischemia-modified albumin; Amputation; Wound healing

Figure

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  Figure 1 Clinical photos show postoperative wound dehiscence (A) and after wound revision operation (B). Amputation evaluation was performed by 3 orthopedic surgeons, and when all sutures were fused without oozing (C), the healing state was assessed union.

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  Figure 2 The graph represents the scatter plot of IMA levels and the periods of wound healing. It shows a positive correlation between IMA levels and the periods of wound healing. IMA: Ischemia-modified albumin.

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